Organization
CREATIVE CHANGES COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE CHRISITNE OHARA LPC (CLINICAL DIRECTOR)
(757) 620-6559
Entity
Organization
Contact information
Practice address
1092 LASKIN RD, SUITE 100, VIRGINIA BEACH, VA 23451-6362
(757) 620-6559
(757) 422-4162
Mailing address
2725 SHORE DR, VIRGINIA BEACH, VA 23451-1335
(757) 620-6559
(757) 422-4162
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701002817
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0803162
OPTIMA PROVIDER NUMBER
—
01
—
185749
ANTHEM PROVIDER NUMBER
—
Enumeration date
05/14/2007
Last updated
08/22/2020
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